Over a third of the beneficiaries who receive opioid prescriptions under Medicare’s Part D program got their prescriptions from more than one doctor, according to a large new study by researchers at Harvard Medical School.
“I thought it would be 5 to 10 percent. When we ran the numbers and it turned out to be 30 percent, we were shocked,” said Anupam Jena, MD, study author and assistant professor of Health Care Policy and Medicine at Harvard Medical School and a physician at Massachusetts General Hospital.
“Our findings not only highlight the dramatic prevalence of multiple provider opioid prescribing among elderly and disabled people but, more importantly, show the adverse health outcomes associated with this fragmented prescribing.”
Jena and his research team looked at a database of 1.8 million Medicare Part D beneficiaries who filled at least one opioid prescription in 2010. About 75% were age 65 or older.
They found that over 40% had prescription from multiple providers. Of those, 23.1% had prescriptions from two providers, 9.5% from three providers and 7.9% from four or more providers.
Patients who obtained opioids through more than one doctor had a significantly higher risk of hospitalization due to respiratory depression, drowsiness and other complications from narcotic use, such as injuries caused by falling.
“Patients with four or more prescribers were twice as likely to be hospitalized for narcotics-related complications than patients receiving the same number of prescriptions from a single caregiver,” said Professor Pinar Karaca-Mandic, a study co-author and assistant professor at University of Minnesota School of Public Health.
The most commonly prescribed opioids were hydrocodone with acetaminophen (Vicodin) (42.9% of all claims), oxycodone with acetaminophen (11.6%), tramadol (11.9%), oxycodone (7.4%), morphine sulfate (4.5%), and fentanyl (4.2%).
Many health systems and state governments today are using prescription drug monitoring programs (PDMP’s) to make it easier for physicians to monitor whether their patients are already receiving opioid prescriptions from another provider. The Harvard study, which is published online in the journal BMJ, suggests that PDMP’s were not being widely used in 2010.
Jena says doctors need to be more aware of what drugs their patients are taking and to communicate with patients about the risks of taking multiple opioids.
“As physicians, we tell patients not to drive when they take opioids, but we also need to tell them that it can be dangerous to receive these medications from more than one provider. And we need to use tools like Massachusetts’ new drug monitoring program to follow up and make sure that doesn’t happen,” Jena said.
In the past two decades, prescriptions for opioid painkillers in the U.S. nearly tripled to over 200 million per year.
Data from two healthcare systems found that long term use of prescription opioids among adults 65 or older increased from 5% of patients in 1997 to 9% in 2005.
Last month the Centers for Medicare and Medicaid Services (CMS) unveiled a series of proposed rule changes that would crackdown on prescription drug fraud and the over-prescribing of painkillers. The regulations would also bring physicians under greater federal oversight by requiring that all doctors or non-physician practitioners who write prescriptions under Part D be enrolled in Medicare.
“Prescription drug abuse is a serious and growing problem nationwide. Unfortunately, the Medicare Part D prescription drug program (Part D) is not immune from the abuses associated with this nationwide epidemic,” the agency said in a statement.
As part of its fraud and abuse strategy, CMS said it would “leverage” information about Part D prescription drug claims by nearly 37 million elderly and disabled Americans by sharing the data with law enforcement agencies, as well as pharmacy and physician licensing boards.